Sleeping Safely! A Quality Improvement Project to Minimize Nighttime Interruptions without Compromising Patient Care.

Sleep is crucial for patients' health but is often disrupted, slowing recovery and resulting in adverse health effects. This study identified whether passive vital sign checks (heart rate, respiratory rate, and pulse oximetry) and delayed routine morning laboratories in clinically stable pediatric patients minimized nighttime interruptions without compromising patient safety. METHODS: After developing the inclusion criteria using the Pediatric Early Warning Score, we enrolled eligible patients for the intervention. We assessed physician compliance through order entry and nursing compliance through recorded vital signs and timing of blood draws. Eligible patients received passive vital sign checks at 4 am with routine morning laboratories drawn at midnight or 6 am, instead of 4 am, to minimize patients' nighttime interruptions. All other nursing duties continued with the institution's patient care policies. Finally, retrospective chart reviews were performed to determine whether the intervention resulted in the escalation of care, our primary outcome. RESULTS: We collected 2,138 individual data points, which represented approximately 420 patients. Over the intervention period, high compliance rates with physician order placement, nurse performing passive vital signs, and delayed blood draws were maintained. On eligible patients, there was no escalation of care or rapid response team involvement. CONCLUSIONS: The use of passive vital sign checks on eligible pediatric patients was generally well-received and had high compliance during the intervention period. There were no negative patient care consequences, supporting the feasibility of this program. Further studies are needed to determine sleep quality and patient satisfaction.

Incidence of Refeeding Syndrome in Children With Failure to Thrive.

OBJECTIVES: To determine the incidence of refeeding syndrome in otherwise healthy children <3 years of age admitted for failure to thrive (FTT). METHODS: A multicenter retrospective cohort study was performed on patients aged ≤36 months admitted with a primary diagnosis of FTT from January 1, 2011, to December 31, 2016. The primary outcome measure was the percentage of patients with laboratory evidence of refeeding syndrome. Exclusion criteria included admission to an ICU, parenteral nutrition, history of prematurity, gastrostomy tube feeds, and any complex chronic conditions. RESULTS: Of the 179 patients meeting inclusion criteria, none had laboratory evidence of refeeding syndrome. Of these, 145 (81%) had laboratory work done at the time of admission, and 69 (39%) had laboratory work repeated after admission. A small percentage (6%) of included patients experienced an adverse event due to repeat laboratory draw. CONCLUSIONS: In otherwise healthy hospitalized patients <3 years of age with a primary diagnosis of FTT, routine laboratory monitoring for electrolyte derangements did not reveal any cases of refeeding syndrome. More robust studies are needed to determine the safety and feasibility of applying low-risk guidelines to this patient population to reduce practice variability and eliminate unnecessary laboratory evaluation and monitoring.

Innovation to Dissemination Workshop: Selecting Outcome Measures to Translate Educational Innovations Into Scholarship.

Introduction: Curricular innovations are invaluable to the improvement of medical education programs, and thus, their dissemination to broader audiences is imperative. However, medical educators often struggle to translate innovative ideas into scholarly pursuits due to a lack of experience or expertise in selecting outcome measures that demonstrate impact. A recent national call for increased focus on outcome measures for medical education research highlights the need for more training in this area. Methods: We developed a 2-hour interactive workshop to improve educator ability to identify outcome measures for educational innovations. This workshop was delivered at a national pediatrics educational conference and at three local institutional faculty development sessions. Results: Participants were diverse in terms of experience, expertise, and roles within their educational programs. Participants rated the workshop positively in each setting and identified next steps in developing their own products of educational scholarship. Discussion: This workshop can provide faculty and faculty developers with a template for developing a skill set in identifying outcome measures and pairing them with educational innovations.